| NPI | 1245261197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064356) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 008100) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-03-29 |